POS0253 FACTORS ASSOCIATED WITH TREATMENT PATHWAYS IN EARLY AXIAL SPONDYLOARTHRITIS: A MULTISTATE ANALYSIS OF THE 10-YEAR FOLLOW-UP OF THE DESIR COHORT
Authors: E. Portier, S. Chevret, A. Ruyssen-Witrand, A. Walter Petrich, M. Dougados, A. Moltó
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Current recommendations for the management of patients with axial spondyloarthritis (axSpA) emphasize the need of individualized strategy in the therapeutic decision [1,2]. Thus, many factors seem to impact this strategy. <h3>Objectives</h3> The objectives of the study were to describe the therapeutic strategies observed in axSpA, and to assess the factors associated with treatment changes over time. <h3>Methods</h3> This study included patients with axSpA from the French prospective cohort DESIR, with a follow-up of 10 years. A multi-state model was built, including 4 treatment states with an increasing gradation ("none", "non-steroidal anti-inflammatory drugs (NSAID)", "conventional synthetic DMARD (csDMARD)", "TNF inhibitors (TNFi)"), and 6 possible transitions from one state to another. Estimation of the restricted mean sojourn times spent in each state from the state occupation probabilities was performed. Then, Cox regression models were used to study the potential impact of factors on transitions. <h3>Results</h3> 686 of the 708 patients which had more than one visit were analyzed. At cohort entry, 199 (29.0%) were untreated, 427 (62.2%) received NSAID, and 60 (8.7%) received csDMARD. Over the 10 years of follow-up, patients mostly received NSAID (46.4% of the time) followed by TNFi (24.4% of the time). In multivariable analysis (<b>figure 1</b>), presence of sacroiliitis on radiography, internal bowel disease and articular index were associated with transition to NSAID. Duration in the previous state was often a significant protective factor associated with transition to csDMARD or TNFi. Finally, the several disease activity outcomes were associated with most transitions. <h3>Conclusion</h3> This was the first study using a multistate model to easily represent the different states, transitions and their associated factors. There appeared to be subcategories of axSpA patients with different management (including some without any treatment), and a significant proportion of patients treated with csDMARD. <h3>References</h3> [1]van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017;76:978–91. https://doi.org/10.1136/annrheumdis-2016-210770. [2]Wendling D, Hecquet S, Fogel O, Letarouilly J-G, Verhoeven F, Pham T, et al. 2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. Joint Bone Spine 2022;89:105344. https://doi.org/10.1016/j.jbspin.2022.105344. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Elodie Portier: None declared, Sylvie Chevret: None declared, Adeline Ruyssen-Witrand: None declared, Anouk Walter Petrich: None declared, Maxime Dougados: None declared, Anna Moltó Consultant of: Abbvie, BMS, Biogen, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Grant/research support from: Pfizer, UCB.